Aetna Case Manager in Shanghai, China
Req ID: 56023BR
Family Summary/MissionDevelop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare in a cost effective manner to establish competitive business advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies.Position Summary/Mission. Provide clinical opinion, advising on programs which help address medical cost drivers, pay for performance, and evidence-based medical protocols, etc. Consult on new business opportunities, responses to tenders and management of partnerships and alliancesFundamental Components & Physical Requirements include but are not limited to
(* denotes essential functions)• Develop and maintain relationships with physician and business leadership of clients, or other health sector organizations• Familiar with international and local practice guidelines in oncology field.Strong review and research experience and ability to summarize. • Communicate with US medical experts to develop clinical standards for key populations.• Responsible for offering advice to medical management programs, including quality management, care management, behavioral health and disease management. Be actively involved in all major clinical program components of the operation of medical management programs.• Promote quality and medical appropriateness of care.• Act as critical business and clinical expert for external parties, including regulatory & accrediting agencies, potential & existing clients and community in general.• Strong in improving and maintaining positive relations with clients, providers, facilities, partners and consultants.• Participate in the development, implementation, maintenance and support of designated customer contracts.Performance MeasuresBackground/Experience DesiredTotal Experience – ideally 10 years post-graduation experience. Minimum 5 years specifically in medicine practice. Currently practice in a 2A hospital or above.Internal medicine and/or oncology focus is strongly desired.The medical director must be open minded to new ways of doing things, excited to be part of a clinical management program, & technologically savvy. Fluent verbal and written English ability.Education and Certification Requirements• Medical License to practice in the China is essential. Oncologist preferred. • Medical Degree graduated from a reputable medical university. • Chengdu Based.
Job Function: Health Care
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.